Provider Demographics
NPI:1659365492
Name:FERGUSON, KEVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 QUAIL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-8559
Mailing Address - Country:US
Mailing Address - Phone:570-850-4041
Mailing Address - Fax:
Practice Address - Street 1:110 S 17TH ST
Practice Address - Street 2:DENTAL DEPT.
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1123
Practice Address - Country:US
Practice Address - Phone:717-231-5761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030353L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist